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08 February 2013

7 signs that a CT scan is needed

Not all kids need a CT scan after blunt trauma to the abdomen, according to a new study that identifies seven key signs to help decide when a scan is unnecessary.

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Not all kids need a CT scan after blunt trauma to the abdomen, according to a new study that identifies seven key signs to help decide when a scan is unnecessary.

The key, researchers said, is determining when CT is worth the risk and when it is unlikely to benefit a young patient's care.

"The prediction rule consisted of (in descending order of importance) no evidence of abdominal wall trauma or seat belt sign, Glasgow Coma Scale score greater than 13, no abdominal tenderness, no evidence of thoracic wall trauma, no complaints of abdominal pain, no decreased breath sounds, and no vomiting," the authors wrote.

Among children with none of these, just one in 1 000 ended up with an acute injury requiring treatment.

Still, a quarter of kids in the study who fit those criteria received a CT in the ER, the researchers found.

"An abdominal CT is the highest CT exposure for kids, and the younger the kid, the higher the exposure," said Dr. James Holmes, who led the new study at the University of California, Davis School of Medicine.

"This is the big radiation risk, and if (the) child really needs the image, they should get it. But if there's no good reason, they shouldn't," said Dr Holmes.

How the study was done

His team's study included just over 12 000 kids seen in 20 ERs after a car or bike crash, fall or other abdominal injury between 2007 and 2010.

Each doctor and hospital decided independently when to do an abdominal scan, and 45% of children ended up getting one while in the ER. Just over 6% of all kids had abdominal injuries spotted on a CT scan, and about 25% of those needed surgery, a blood transfusion or another intervention.

Based on kids' symptoms and who ended up needing treatment, Dr Holmes and his colleagues designed their seven-point checklist to determine when a CT scan is not warranted:

Dr Holmes said that for an infant, the risk of developing cancer after a single abdominal and pelvic CT scan might be as high as 1 in 200. By adolescence, that risks drops to 1 in 1 000 or 1 in 1 500.

There are times when a CT scan is clearly warranted to help doctors find or rule out serious injuries such as a lacerated spleen or liver, Dr. Holmes said.

"You're looking at those things that need to be identified because they need therapy, either an operation to repair their gastrointestinal injury, or perhaps an embolization to repair a bleeding artery," he said.

In those cases, "You don't want to send that patient home, because if they need that therapy, they're not going to get it" - and waiting can make things worse.

(Reuters Health, February 2013)

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